The increasing number of patients with COPD throughout the world is strongly associated with the worrisome tobacco smoking trend. Nearly 30% of the global population smokes, and at least 15 to 20 % of these smokers will go on to develop COPD. Currently, the prevalence of COPD ranges from 8 to 20 % in various countries. The burden of this disease has implications not only in terms of economic costs but also for overall quality of life and longevity. To counter the effects of COPD, a considerable number of medical interventions are continually emerging both for the prevention and treatment of COPD.

The current approach to treatment in patients with COPD is simultaneously easy and difficult. On one hand, there are several guidelines that address the most relevant pharmacological and non-pharmacological interventions in a point-by-point fashion. Likewise, it is easy because once the most common etiological factor has been clearly identified, the central recommendation - to stop smoking - can be made. On the other hand, treatment decisions can often be difficult, especially when the respiratory physician has a number of guidelines and recommendations from which to choose.

Two of the most controversial issues in the treatment of these patients are the initiation of inhaled steroids (IS) in the stable patient and the use of antibiotics to manage exacerbations. There are 5 major guidelines for COPD: GOLD, NICE, American Thoracic Society/European Respiratory Society (ATS/ERS), the Spanish and Latin American guidelines (SEPAR/ALAT) and the Canadian Thoracic Society COPD guidelines. All of these agree that IS should be commenced when FEV1 is < 50% of predicted and all the guidelines accept and recommend the use of systemic corticosteroids for exacerbations. However, whereas the GOLD recommendations state that IS should be considered when at least 3 exacerbations per year have been recorded, the ATS/ERS guidelines suggest that IS should already be prescribed when 1 exacerbation/year has occurred. As for antibiotics, clinical criteria prevail as to their use in treating exacerbations. The early use of long-acting anticholinergics such as tiotropium bromide, and the recommendation of pulmonary rehabilitation are topics deserving of more attention.

Treatment of COPD is definitely a hot topic and it is certainly a challenge to become familiar with the different options to follow. In this series, Dr. Álvarez-Sala and coworkers have done an excellent job of revising the available guidelines and presenting the different options in easy-to-read tables, to familiarize the reader with the different guidelines. Furthermore, the authors suggest different ways to modify each guideline if, despite recommendations, the patient’s symptoms persist. Dr. Jardim has carried out a brief and precise revision of pulmonary rehabilitation and Dr. Gross has summarized the effects of tiotropium bromide, including the pharmacological, clinical and functional properties as well as safety and pharmacoeconomic aspects.